You’re Not Crazy – It’s PMS Part 1

RoseMarie Pierce, B.Sc. Pharm.

Until recently, the orthodox medical profession has regarded PMS (premenstrual syndrome) as mostly an imaginary or psychological disorder. Mood swings, impulsive behavior, irritability, depression and crying spells have often been misdiagnosed as purely psychological. Interestingly, medical doctors did not routinely address the topic of PMS in their medical training until after women began coming to them with their self-diagnoses, states Dr. Christiane Northrup, an internationally recognized speaker for women’s health and a well-known author. The demand created by women and the media for treatment of PMS in the early 1980’s initiated a great deal of medical research and an increase in the number of medical journal articles published. Women’s desire to understand PMS has been a major influence in the improved and more enlightened attitude we now have toward the female body.

What is PMS and What are the Symptoms?

For 10 to 14 days each month, many women experience sudden mood swings, depression, anxiety, food cravings, weight gain, headaches, acne, nausea, cramping, breast tenderness and many other physical and emotional discomforts (see table – PMS Symptoms). At least 60 percent of menstruating women endure some symptoms of PMS and 5 to 10 percent have serious, incapacitating PMS. Occurring during the 2 weeks prior to the beginning of the menstrual period, these symptoms characteristically disappear by the first 1-2 days of menstruation. The important factor in women with classic PMS is that these symptoms recur cyclically, on a monthly basis, or almost every month.

Beyond these physical aspects, the emotional component of PMS offers an opportunity to identify and work with the feelings of fear, extreme sensitivity, irritation and even anger. These feelings may have been suppressed throughout the month and can flare up disproportionately during the time of PMS discomfort. It is important to remember that being extra sensitive can also mean being more intuitive, creative, unconstrained, natural or real in the world. Working with these uncomfortable, maybe even intolerable, feelings to learn more about one’s self and one’s unresolved issues could offer an easier passage through menopause. The uncomfortable symptoms of PMS, as stated by Dr. Northrup in her book The Wisdom of Menopause, will be magnified and prolonged if a woman is carrying a heavy load of unresolved emotion baggage.

What causes PMS?

The term “premenstrual syndrome” (PMS) was coined in 1931 when researchers first suggested that the condition could be due to a hormonal imbalance related to the menstrual cycle. The complex hormonal interactions required in producing a “normal” menstrual cycle can be upset by a number of environmental, biochemical and psychological sources. Since a woman’s response to her own cyclical reproductive hormones is very individual, it is difficult to pin down the cause of PMS. However, many researchers and doctors are suggesting that an excess of estrogen relative to progesterone during the second half of the menstrual cycle (after ovulation) is behind many women’s health conditions including PMS, endometriosis, fibroids, infertility, ovarian cysts, and perimenopausal symptoms.

What role does excessive estrogen play in PMS?

Women with PMS tend to have relatively high levels of estrogen coupled with relatively low levels of progesterone. Excessive estrogen leads to water retention, fibrocysts in the breast, fat storage, gallbladder problems and hormone-related cancers. High estrogen levels can also have an effect on neurotransmitters in the brain such as serotonin, a chemical that plays a role in mood and mental function. Symptoms of estrogen excess include bloating, weight gain, breast tenderness, headaches, and backaches. The most common symptoms of PMS are also the same symptoms produced by excessive estrogen, according to women’s health expert John R. Lee, M.D., who coined the term “estrogen dominance”. Excessive estrogen or “estrogen dominance” can be due to an over-exposure to estrogen (produced in the body naturally or taken as estrogen therapy) and/or due to estrogen-mimicking chemicals known as xenoestrogens. Xenoestrogens are increasingly prevalent in our food supply (hormone-raised livestock and commercially-grown fruits and vegetables) and in our environment (herbicides, pesticides, plastics, solvents, glues, automobile exhaust and petrochemical by-products). The body responds as if xenoestrogens are real estrogen, effecting and often disrupting the reproductive abilities and hormonal balance of all living creatures, including humans.

What other factors increase the estrogen load on the body?

Alcohol markedly increases estrogen levels in both men and women by affecting the liver enzymes responsible for estrogen metabolism or breakdown. This adds to the estrogen overload. A diet high in refined carbohydrates (sugars and starches) creates a tendency toward central obesity (abdominal fat) and high insulin levels, which is turn favors production of estrogen. Constipation also presents a problem. Normally, estrogen is “conjugated” or bound to proteins in the liver and is eventually excreted with the bile into the small intestines. Much of the surplus estrogen, in this way, is eliminated from the body through the feces. However, if estrogen stays too long in the intestines due to constipation and/or poor normal intestinal bacterial action, it will be reabsorbed by the intestinal walls and will contribute to increased levels of the hormone.

What effect do low blood levels of progesterone have on PMS?

A progesterone imbalance can affect women of all ages. For most women, the smooth functioning of the hormonal interplay remains optimal in the late teens and twenties yet, by the time a woman reaches her thirties, the menstrual system often begins to malfunction. By the mid-thirties a number of women fail to ovulate. Without ovulation, the naturally occurring rises in the production of progesterone (from 2-3 mg. to 20-30 mg.) throughout the second half of the female cycle can not occur. This decline becomes significant as women get closer to menopause. Because progesterone balances estrogen by “down-regulating” the estrogen receptor cells in the breast, uterus, and vaginal lining tissue, it blocks estrogen’s “grow” signals. If the natural rise in progesterone is not produced, the result is period irregularities and the proliferation of estrogen sensitive cells due to the negative effects of even modest amounts of estrogen.

When a woman regularly misses her period or commonly bleeds (spots) between periods, she has a condition called “dysfunctional uterine bleeding”. The condition is frequently associated with this decreased supply of progesterone, though thyroid or pituitary problems are other possible contributing factors. Conversely, it is known that adequate thyroid gland function is necessary for the production of progesterone.

Other possible causes cited for an anovulatory cycle and low progesterone production would include mental, emotional or physical stress (to be discussed in more detail in Part 2), extreme dieting, excessive exercise such as marathon running, poor diet, and vitamin and mineral deficiencies.

RoseMarie Pierce, B.Sc.Pharm, earned her degree in Pharmacy from Dalhousie University in 1972. After extensive studies in herbal and nutritional medicine, RoseMarie integrated these disciplinary practices with her pharmacy education to become Canada’s first Holistic Pharmacist.